Patient Case: 74-year-old multiple myeloma patient with MDRO

Institution Withheld

Hospital in the U.S.

Febrile Neutropenia Patient

74 yo man on chemotherapy for multiple myeloma. Neutropenia started in hospital 7 days later, and 3 days later, the patient became febrile and tachycardic.

Empiric therapy Vancomycin, meropenem
ID/AST method Accelerate PhenoTest® BC kit
ID result Pseudomonas aeruginosa
Therapy change Ceftolozane-tazobactam
AST results Amikacin (R), cefepime (R), ceftazidime (R), ciprofloxacin (R) , gentamicin (I), meropenem (I), piperacillin-tazobactam (R)
Therapy continuation Ceftolozane-tazobactam
Time to AST results ∼6.5h post +BC with Accelerate PhenoTest® BC kit (vs. traditional methods of ∼53h)
Patient outcome Discharged home

Case Discussion

A 74-year-old man was admitted for chemotherapy for multiple myeloma. The patient’s chemotherapy, with concurrent anti-microbiological prophylaxis consisting of acyclovir, levofloxacin and fluconazole, was started on the day of admission. Neutropenia started on hospital day 7. Three days thereafter, at 20:33, the patient became febrile (Tmax 38.4°C), and tachycardic (HR in the 100s). The following day, vancomycin and meropenem were started and blood cultures and urine cultures were collected. Blood cultures revealed Pseudomonas aeruginosa, which was found to be multi-drug resistant. Due to this finding, the patient was escalated to ceftolozane-tazobactam, 9.7 hours after the culture flagged positive.

Routine AST results were available 53 hours after the blood culture was positive, and included confirmation of ceftolozane-tazobactam susceptibility, an antimicrobial that was prospectively tested due to the multi-drug resistant profile demonstrated by the Accelerate PhenoTest BC kit.

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